Originally published by 2 Minute Medicine® (view original article). Reused on AccessMedicine with permission.

1. In national data from undercover compliance checks of tobacco sale laws, approximately 80% of stores requested identification from minors, but sales after identification requests constituted nearly one-quarter of all violations.

2. Identification request rates were lower, and violations were higher during vaping product purchase attempts than during cigarette purchase attempts.

Evidence Rating Level: 3 (Average)

Study Rundown:

While tobacco laws in the United States require stores to examine proof-of-age identification and refuse to sell to customers <18 years of age, many violations occur, and vaping remains prevalent among adolescents. Small studies have shown that after examining identification, retailers often sell tobacco to minors despite being shown the customer’s age. In this national cross-sectional study, researchers used data from tobacco sale law compliance checks in 2017 to 2018 to examine the rate of compliance checks and retailer violations across states and tobacco products. While identification was requested in about 80% of compliance checks, sales after identification requests constituted nearly one quarter of all violations. Violation rates were higher when states required undercover youth inspectors to carry identification. During vaping product purchase attempts, stores were significantly less likely to request identification and significantly more likely to commit a violation. Most types of stores were significantly less likely to commit a sales violation than convenience stores.

This study was limited by the inclusion of only states that provided optional information during data reporting. Nonetheless, the study is strengthened by its large sample across several regions and comparison of states with different identification laws. For physicians, these findings highlight the importance of advocating for strengthening of tobacco laws, especially regarding the sale of vaping products, to address tobacco use in adolescents.

In-Depth [cross-sectional study]:

Researchers used national data from tobacco sale law compliance checks in 2017-2018 at a random sample of retail stores submitted by U.S. states to the Substance Abuse and Mental Health Services Administration to estimate rates of identification requests and retailer violation rates. Multivariable analysis was used to model factors contributing to identification-request failures and sales violations, including minor age, sex, type of tobacco requested, and whether the state required or forbade minors to carry identification.

The sample included 17 726 compliance checks, during which identification was requested in 79.6% of observations (95% confidence interval [CI]: 78.9%-80.4%). The overall retailer violation rate was 9.3% (95% CI: 8.7%-9.9%), and sales after identification requests accounted for 22.8% of all violations (95% CI: 20.0%-25.6%). States that required minors to carry identification during compliance checks had a significantly higher identification-request rate than states that forbade minors from carrying identification. Carrying identification was associated with >3 times the likelihood of being asked to show identification (adjusted odds ratio [aOR] 3.69; 95% CI: 1.60-8.50) and more than twice the likelihood of being sold tobacco (aOR 2.73; 95% CI: 1.71-4.36), after adjustment for other factors. Stores were 35% less likely to request identification for purchase of vaping products than for purchase of cigarettes (aOR 0.65; 95% CI: 0.51-0.83), and 42% more likely to commit a sales violation (aOR 1.42; 95% CI: 1.05-1.91). Most types of stores were significantly less likely to commit a sales violation than convenience stores.

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